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Rare presentation of intractable tuberculous panophthalmitis with intraocular and intraorbital abscesses: a case report.

Rare presentation of intractable tuberculous panophthalmitis with intraocular and intraorbital abscesses: a case report.
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Boonsopon S, Tesavibul N, Uiprasertkul M, Leeamornsiri S, Choopong P,


Boonsopon S, Tesavibul N, Uiprasertkul M, Leeamornsiri S, Choopong P, (click to view)

Boonsopon S, Tesavibul N, Uiprasertkul M, Leeamornsiri S, Choopong P,

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Journal of medical case reports 2017 07 0411(1) 180 doi 10.1186/s13256-017-1353-9

Abstract
BACKGROUND
We report a rare presentation of extrapulmonary tuberculosis.

CASE PRESENTATION
A 29-year-old Burmese woman with human immunodeficiency virus infection and known pulmonary tuberculosis who had been treated for 5 months presented to our hospital with unilateral progressive painful visual loss of 1 month’s duration. She was diagnosed with tuberculous panophthalmitis with subretinal and intraorbital abscesses, conjunctival abscess, and extraocular muscle tuberculoma. The diagnosis was confirmed by a conjunctival pus swab with a positive result for acid-fast bacilli and a positive result for a mycobacterial culture. There was high suspicion of multidrug-resistant tuberculosis. Despite receiving ongoing aggressive treatment with conventional antituberculous medications, this patient required subtotal orbital exenteration to control her infection and prevent further progression. Second-line antituberculous medications were added to the first-line therapy, with satisfactory results achieved.

CONCLUSIONS
Tuberculous panophthalmitis with intraocular and intraorbital abscesses is a rare presentation of extrapulmonary tuberculosis. Patients who do not respond to first-line antituberculous therapy might be infected with either single-drug or multidrug-resistant Mycobacterium tuberculosis. Patient compliance is one of the key factors that can alter the course of treatment. Careful patient monitoring can improve disease progression, outcome, and prognosis.

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